AIDS in India – Essay

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Concept:

AIDS (Acquired Immuno-Deficiency Syndrome) is a disease which is caused by a virus called Human Immunodeficiency Virus or HIV. This virus is fatal and dangerous because it destroys the immune system (the capacity of the body to fight diseases) in the human body and remains in the body for years together without any visible symptoms. This virus is smaller than even bacteria and is not observable even with the micro­scope.

The virus can be transmitted to other persons in a number of ways. AIDS is the last stage of infection in the virus. It takes about eight to ten years between getting infected with HIV and developing AIDS. No vaccine has been invented till today as a cure for AIDS or for pro­tecting people from the HIV, though some scientists claimed in October 1995 that it was likely to be invented in the foreseeable future.

In the United States and some other countries like France, Belgium, Uganda, Zambia, Tanzania, Zimbabwe, etc., the AIDS emerged in the 1980s, though the first AIDS case of a person of 45 years of age was de­tected in America in 1959. In India, the first case of HIV infection was reported in May 1986 in Madras.

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The National Institute of Virology, Pune, and the Christian Medical College, Vellore, started ‘screening op­erations’ in 1987 on the recommendations of AIDS Task Force of Indian Council of Medical Research, New Delhi. It screened 3,027 persons of high risk groups and detected a good number of cases as being seroposi­tive (Thomas, 1994:12).

Magnitude:

HIV is currently spreading in the world at the rate of one new infection every fifty seconds. The HIV/AIDS is not confined to any one class, community, religion, age-group, sex or profession, though according to the Indian Health Organization (IHO), women and children are believed to be more prone to AIDS (The Hindustan Times, April 7, 1995).

The HIV infection is spread over all regions and all groups. The enormity of the problem, and the concern generated by it glob­ally, can be gauged by the fact that in the last week of January 1988 a historic and unprecedented meeting took place in London. It was the World Summit of Ministers of Health from 148 countries along with health experts: the first occasion when a single disease syndrome was discussed at that level.

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Enough to show the panic situation set in motion by AIDS. The historic London Declaration, emerging from the meeting stated: “In the absence at present of a vaccine or cure for AIDS, the sin­gle most important component of National AIDS Programme is information and education” (Parvi, 1992: 89). In mid-1992, the highest number of HIV infected cases were found in American region (2.77 lakh), followed by African region (1.51 lakh), and South East Asia region. As regards AIDS cases, in South-East Asia, Thailand was leading with 1,589 cases (up to June, 1993), followed by 336 in India, 47 in Myanmar, 31 in Indonesia, 24 in Sri Lanka, 18 in Ne­pal, and 2 in Bangladesh (The Hindustan Times, December 7, 1993).

The World Health Organization (WHO) estimates that 11 to 13 million peo­ple are infected with the HIV virus and about 2 million suffer from AIDS in the whole world. It further holds that by the year 2,000, there will be 12 to 18 million AIDS cases, and over a million AIDS death cases a year, the majority being in developing countries-about half a mil­lion in Africa and about a quarter million in Asia (Seminar, No. 396, August 1992:12).

In India, according to the estimate made by Indian Health Organiza­tion, there were lakhs of HIV positive and full-blown AIDS cases at the end of 1994 (The Hindustan Times, April 7, 1995). However, officially 1,036 full-blown AIDS cases and 21,764 HIV carriers were reported till February 1, 1996 (The Hindustan Times, March, 2 1996).

Three years from now (i.e., in 2,000), India—the second most populated country in the world—may have the dubious distinction of hosting over a large number of AIDS patients and lakhs of persons infected with HIV virus. According to an estimate made by the World Health Organization re­gional office for South-East Asia, India has over 65 per cent of the HIV infected individuals in the region, followed by Thailand (23%), and My­anmar (7%) (Ibid).

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The WHO has also estimated that by the year 2,000 A.D., 4 million Indians will be infected by the HIV, and over, 1, 70,000 would have AIDS (The Hindustan Times, November 28, 1996). The AIDS Research and Control Centre, Mumbai had earlier estimated that there would be about 50,000 full-blown cases in our country by the end of the year 1995 and about 10 lakh persons would be suffering from the HIV infection. The Pune Centre was also of the opinion that the prosti­tutes of red-light area of Mumbai alone produce three to four HIV infected cases every one hour.

This means that out of 400 new HIV in­fested cases every 15 minutes in the world, one is produced in Mumbai. The Indian Health Organization, Pune has estimated that about 10,000 people will die every day in India by the turn of the century on account of this man-made calamity, leaving 20,000 children orphans and 5,000 widows daily (The Hindustan Times, April 7, 1995).

In India, the rate and pattern of HIV infection is not uniform in vari­ous states. The highest number of AIDS cases is found in Mumbai, which is known as AIDS capital of India. It has 30 to 35 per cent of the country’s recorded AIDS cases and HIV carriers, although half of the patients are from other states. Mumbai is followed by Chennai in Tamil Nadu, Thiruvananthapuram in Kerala in South India, Nagpur, Aurangabad and Kolhapur in Maharashtra in West India, Mizoram, Manipur and Nagaland in East India, and Delhi in North India. In India, the states that have not reported any HIV positive cases may be because of poor surveillance.

It does not necessarily mean they are HIV- free (The Times of India, January 29, 1996). In Rajasthan, 23,689 blood samples screened by the Rajasthan Medical and Health Department in six cities from August 1992 to August 1996 revealed that 4.4 per cent samples were HIV positive. Of these (1,051) cases, the highest number was in Jaipur (41%) followed by Jodhpur (22%), Ajmer (15%), Kota (11%), Bikaner (6%) and Udaipur (5%) (The Times of India, September 18, 1996) .

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However, the number game is irrelevant. What is relevant is the huge threatening potential of the infection. The challenge we are faced with is developmental challenge, to make people change their behaviour patterns and lifestyles for potential future benefits.

High Risk Groups and Means of Transmitting the Virus:

HIV infection is not contagious in the same sense as measles, chicken- pox, tuberculosis, cholera, plague or small-pox. It mainly spreads through a sexual route and blood to blood contact.

It may be said that HIV spreads mainly through four sources:

(i) Sex with an infected part­ner—heterosexual as well as homosexual,

(ii) Transfusion of blood and blood products infected with HIV,

(iii) Injecting drugs with infected syr­inges or needles, and

(iv) Infected mother to her unborn child, there being 30-50 per cent chance of transmission with each delivery.

In a study in Pune, it was found that 80 per cent HIV cases related to sexual promiscuity, 5 per cent to blood transfusion and 4 per cent to injecting drugs with infected syringes. Of the 1,108 HIV cases reported to NACO, 75.2 per cent related to heterosexual promiscuity, 11.1 per cent to blood transfusion and 8.7 per cent to intravenous drug users (The Hindustan Times, June 6, 1995).

It is thus a myth to believe that HIV infection spreads through mosquitoes, holding/embracing/kissing each other, shaking hands, coughing, sneezing or spitting, sharing of public toilets, swimming pools, sharing meals or eating from the same plates and cut­lery, through clothes and bed sheets, by attending the same school or work-place, etc. There are no reports of doctors, nurses and other health­care workers becoming infected with HIV or developing AIDS from direct contact with a patient.

According to Indian Health Organization, housewives are more prone to spreading HIV infections. In a study of screening 25,000 mid­dle-class pregnant women by the IHO in collaboration with Wadia Hospital, Mumbai in 1994, 210 women were tested HIV positive. The husbands of about 90 women were also HIV infected.

However, the married woman’s own risk to HIV was found to be extremely low, though her husband’s risk behaviour made her vulnerable. In 96 per cent couples with HIV, husband was found to be the person who had con­tacted HIV infection through extra-marital sex. No wonder, after testing HIV positive, women were advised to avoid future pregnancy and al­most all opted for barrier contraception or tubectomy. We will now analyze the main sources of transmission of virus, i.e., prostitutes, homosexuals, intravenous drug addicts, blood donors, patho­logical laboratories, and mothers with HIV infection giving birth to children.

Prostitutes (female sex workers) sell sex. There are believed to be about 20 lakh prostitutes distributed over 817 red-light areas in different parts in India. This does not include the number of call-girls (Social Wel­fare, Delhi, June 1990). A large number of these prostitutes and call-girls are infected with HIV who pass on the infection to their cus­tomers.

According to one estimate, the level of HIV infection escalated from one per cent to 30 per cent among prostitutes in Mumbai in just three years—from 1989 to 1991. There is also a view that prostitutes are at a lower risk of infecting their clients and at a higher risk of getting in­fected by them. Therefore, along with targeting the preventive programmes to prostitutes they should also cover their clients.

Homosexuals in India are looked down upon with hostility unlike in the United States, Britain, etc., yet, it is a fact that the emerging institutions of gays like ‘Mumbai Dost’ indicate a changing attitude towards the homosexuals. Though homosexuality is still an offence under the In­dian Penal Code, but the long-held taboos about homosexuality are now beginning to break.

The homosexuals are found in prisons, correctional reformatories, Rescue Homes, etc. Outside these institutions also, they are found in thousands. The distribution of condoms to prisoners in Tihar Jail, Delhi had drawn a serious discussion in this context in 1994 to the extent that the matter was even referred to the court. The risk of HIV infection through homosexuality is indeed very real.

Drug addicts, who take drugs by injection, carry the possibility of spreading the HIV infection through infected needles. The use of drugs is spreading rapidly among students, industrial workers, truck and auto- rickshaw drivers, and cycle-rickshaw pullers and people living in slum areas. A good number of drug-users gradually become so addicted to drugs that they start taking them by self-injection.

Sometimes the same syringes are used by many drug-addicts increasing the possibility of spreading the HIV infection. In Manipur, where 40 to 50 per cent of in­travenous drug users are HIV positive, many have been sent to jail, in some cases even by their own parents. Among them are children of sen­ior government officials as well as of those in business, politics and academics (Seminar, August, 1992:13).

Blood-donors to transmit the HIV infection. There are estimated to be 1,020 blood banks in our country which supply about 20 lakh bottles of blood every year. Half of these blood banks are government banks and the remaining half is unlicensed. There are some professional blood donors also whose blood sometimes contains the HIV. When their blood is transfused to patients without proper testing, the HIV is trans­mitted. The pathological laboratories too similarly transmit the HIV when they supply blood without scientific testing.

Pregnant women who have positive HIV transmit the virus to the new-born children. On one hand, about 65 per cent of the pregnant women remain anaemic and require blood transfusion and on the other hand, the prostitutes give birth to about 50 lakh children every year. They are thus doubly vulnerable to transmitting the HIV.

Use of blade for shaving, particularly the one used by the barbers, is also a risk factor in spreading the HIV. A study conducted by the Directorate of Health Services, Manipur in 1991 pointed out that in the analysis of 6,680 specimens of HIV, the highest risk factor (93.9%) in spreading HIV were found to be intrave­nous drug addicts, followed by blood donors (2.93%) and homosexuals (2.61 %) (Health For Millions, Vol. XVII, No. 4, New Delhi, August 1991).